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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2014

01-08-2014 | Knee

No influence of coronal laxity and alignment on lift-off after well-balanced and aligned total knee arthroplasty

Authors: Satoshi Hamai, Hiromasa Miura, Ken Okazaki, Takeshi Shimoto, Hidehiko Higaki, Yukihide Iwamoto

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2014

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Abstract

Purpose

In vivo fluoroscopic analyses have revealed the kinematics after total knee arthroplasty (TKA), including femoral condylar lift-off. This study asked whether differences in static varus–valgus laxity or coronal limb alignment after TKA affect lift-off under weight-bearing conditions. It was hypothesised that there is a correlation between coronal laxity or alignment and lift-off during walking.

Methods

The current study analysed nineteen subjects undergoing cruciate-retaining TKA performed by the measured resection technique. The varus–valgus laxity at knee extension was measured using a 150 N stress radiograph. The mechanical axis was measured using a full-standing radiograph. Continuous radiological images were taken while the subject walked on a treadmill, and the images during single-leg stance were analysed to determine the lift-off using a 3D-to-2D image-to-model registration technique.

Results

The average angle in varus/valgus stress was 6.8 ± 1.8°/6.6 ± 2.1°. No statistically significant differences were observed between the varus and valgus laxity. The average amount of lift-off was 0.7 ± 0.4 mm. The static varus–valgus laxity (n. s.) or the differences in the laxities (n. s.) on the stress radiograph did not influence lift-off. The weight-bearing ratio was achieved within the middle third of the knee in 90 % of subjects. Two outliers with valgus alignment (68 ± 1 %) demonstrated no significant difference in lift-off in comparison with the majority of the subjects (46 ± 9 %).

Conclusion

The static coronal laxity and alignment did not influence the lift-off under dynamic weight-bearing conditions after well-balanced and aligned cruciate-retaining TKA. Measured resection technique can produce sufficient coronal stability and alignment without significant lift-off during walking.

Level of evidence

IV.
Literature
1.
Andriacchi TP, Stanwyck TS, Galante JO (1986) Knee biomechanics and total knee replacement. J Arthroplasty 1(3):211–219PubMedCrossRef
2.
Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107PubMedCentralPubMedCrossRef
3.
Dennis DA, Komistek RD, Mahfouz MR (2003) In vivo fluoroscopic analysis of fixed-bearing total knee replacements. Clin Orthop Relat Res 410:114–130PubMedCrossRef
4.
Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB (2001) Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Joint Surg Br 83(1):33–39PubMedCrossRef
5.
D’Lima DD, Patil S, Steklov N, Slamin JE, Colwell CW Jr (2006) Tibial forces measured in vivo after total knee arthroplasty. J Arthroplasty 21(2):255–262PubMedCrossRef
6.
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24(6 Suppl):39–43PubMedCrossRef
7.
Garling EH, Kaptein BL, Geleijns K, Nelissen RG, Valstar ER (2005) Marker Configuration Model-Based Roentgen Fluoroscopic Analysis. J Biomech 38(4):893–901PubMedCrossRef
8.
Hamai S, Miura H, Higaki H, Matsuda S, Shimoto T, Sasaki K, Yoshizumi M, Okazaki K, Tsukamoto N, Iwamoto Y (2008) Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplasties. J Orthop Res 26(4):435–442PubMedCrossRef
9.
Hamai S, Miura H, Higaki H, Shimoto T, Matsuda S, Iwamoto Y (2008) Evaluation of impingement of the anterior tibial post during gait in a posteriorly-stabilised total knee replacement. J Bone Joint Surg Br 90(9):1180–1185PubMedCrossRef
10.
Hamai S, Miura H, Higaki H, Shimoto T, Matsuda S, Okazaki K, Iwamoto Y (2008) Three-dimensional knee joint kinematics during golf swing and stationary cycling after total knee arthroplasty. J Orthop Res 26(12):1556–1561PubMedCrossRef
11.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
12.
Insall JN, Scuderi GR, Komistek RD, Math K, Dennis DA, Anderson DT (2002) Correlation between condylar lift-off and femoral component alignment. Clin Orthop Relat Res 403:143–152PubMedCrossRef
13.
Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G (2003) Coronal laxity in extension in vivo after total knee arthroplasty. J Orthop Sci 8(4):538–542PubMedCrossRef
14.
Ishii Y, Noguchi H, Matsuda Y, Takeda M, Walker SA, Komistek RD (2007) Effect of knee laxity on in vivo kinematics of meniscal-bearing knee prostheses. Knee 14(4):269–274PubMedCrossRef
15.
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed
16.
Jennings LM, Bell CI, Ingham E, Komistek RD, Stone MH, Fisher J (2007) The influence of femoral condylar lift-off on the wear of artificial knee joints. Proc Inst Mech Eng H 221(3):305–314PubMedCrossRef
17.
Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y (2001) Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 391:210–217PubMedCrossRef
18.
Kanekasu K, Banks SA, Honjo S, Nakata O, Kato H (2004) Fluoroscopic analysis of knee arthroplasty kinematics during deep flexion kneeling. J Arthroplasty 19(8):998–1003PubMedCrossRef
19.
Komistek RD, Scott RD, Dennis DA, Yasgur D, Anderson DT, Hajner ME (2002) In vivo comparison of femorotibial contact positions for press-fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties. J Arthroplasty 17(2):209–216PubMedCrossRef
20.
Lee DH, Park JH, Song DI, Padhy D, Jeong WK, Han SB (2010) Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc 18(3):381–387PubMedCrossRef
21.
Lee SY, Matsui N, Kurosaka M, Komistek RD, Mahfouz M, Dennis DA, Yoshiya S (2005) A posterior-stabilized total knee arthroplasty shows condylar lift-off during deep knee bends. Clin Orthop Relat Res 435:181–184PubMedCrossRef
22.
Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty 16(5):635–640PubMedCrossRef
23.
Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC (1981) The role of joint load in knee stability. J Bone Joint Surg Am 63(4):570–585PubMed
24.
Matsuda S, Miura H, Nagamine R, Urabe K, Harimaya K, Matsunobu T, Iwamoto Y (1999) Changes in knee alignment after total knee arthroplasty. J Arthroplasty 14(5):566–570PubMedCrossRef
25.
Matsuda S, Whiteside LA, White SE (1999) The effect of varus tilt on contact stresses in total knee arthroplasty: a biomechanical study. Orthopedics 22(3):303–307PubMed
26.
Matsuda Y, Ishii Y (2004) In vivo laxity of low contact stress mobile-bearing prostheses. Clin Orthop Relat Res 419:138–143PubMedCrossRef
27.
Moro-oka TA, Shiraishi H, Iwamoto Y, Banks SA (2010) Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 18(3):375–380PubMedCrossRef
28.
Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M, Iwamoto Y (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11(3):264–266PubMedCrossRef
29.
Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 19(9):1496–1503PubMedCrossRef
30.
Petersen TL, Engh GA (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 3(1):67–72PubMedCrossRef
31.
Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93(17):1588–1596PubMedCrossRef
32.
Sasanuma H, Sekiya H, Takatoku K, Takada H, Sugimoto N, Seo JG (2010) Evaluation of soft-tissue balance during total knee arthroplasty. J Orthop Surg (Hong Kong) 18(1):26–30
33.
Seo JG, Moon YW, Park SH, Shim JW, Kim SM (2012) An alternative method to create extramedullary references in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(7):1339–1348PubMedCrossRef
34.
Schmidt R, Komistek RD, Blaha JD, Penenberg BL, Maloney WJ (2003) Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants. Clin Orthop Relat Res 410:139–147PubMedCrossRef
35.
Schulz MS, Russe K, Lampakis G, Strobel MJ (2005) Reliability of stress radiography for evaluation of posterior knee laxity. Am J Sports Med 33(4):502–506PubMedCrossRef
36.
Scuderi GR, Komistek RD, Dennis DA, Insall JN (2003) The impact of femoral component rotational alignment on condylar lift-off. Clin Orthop Relat Res 410:148–154PubMedCrossRef
37.
Shelburne KB, Torry MR, Pandy MG (2006) Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res 24(10):1983–1990PubMedCrossRef
38.
39.
Stiehl JB, Dennis DA, Komistek RD, Crane HS (1999) In vivo determination of condylar lift-off and screw-home in a mobile-bearing total knee arthroplasty. J Arthroplasty 14(3):293–299PubMedCrossRef
40.
Stiehl JB, Komistek RD, Haas B, Dennis DA (2001) Frontal plane kinematics after mobile-bearing total knee arthroplasty. Clin Orthop Relat Res 392:56–61PubMedCrossRef
41.
Wasielewski RC, Galat DD, Komistek RD (2005) Correlation of compartment pressure data from an intraoperative sensing device with postoperative fluoroscopic kinematic results in TKA subjects. J Biomech 38(2):333–339PubMedCrossRef
Metadata
Title
No influence of coronal laxity and alignment on lift-off after well-balanced and aligned total knee arthroplasty
Authors
Satoshi Hamai
Hiromasa Miura
Ken Okazaki
Takeshi Shimoto
Hidehiko Higaki
Yukihide Iwamoto
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2500-5

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